MAGPIE
Magnesium Sulphate for Prevention of Eclampsia trial
Patient / Population Intervention / Exposure Comparison Outcome
In 10,141 women with pre-eclampsia before delivery or shortly afterwards, magnesium sulphate halved the risk of eclamptic convulsions compared with placebo, without reducing perinatal death.
N
10,141
Design
International, placebo-controlled RCT in 33 countries
Endpoint
Eclampsia; and, for women randomised before delivery, death of the baby
Relevance
1
ResultEclampsia 0.8 % vs 1.9 % — a 58 % lower risk (95 % CI 40–71). No clear difference in death of the baby (12.7 % vs 12.4 %). Side effects, mainly flushing, in 24 % vs 5 %.
Altman D, Carroli G, Duley L, et al. Lancet. 2002;359(9321):1877-1890. 10.1016/S0140-6736(02)08778-0
Discussion & critique
The absolute benefit is modest where baseline eclampsia rates are low, a quarter of treated women had side effects, and perinatal death was unchanged. But with 10,141 women across 33 countries it settled the question definitively: magnesium sulphate, not phenytoin or diazepam, is the anticonvulsant of choice in pre-eclampsia.